For Clinicians

Is Obesity a Chronic Disease? Understanding the Medical and Social Implications

The debate over whether obesity is a chronic disease has major implications for how we treat it — and who pays.

Sharon Cebik, MD | Medical Provider · May 2, 2023 · 6 min read

Obesity is a growing concern in the US, with the number of cases hitting a record high yearly. About two out of three adults in the US are overweight or obese; obesity accounts for over 30% of US adults. A 2022 report by the Trust for America’s Health revealed that 19 states in the US have an obesity rate of over 35%. This trend worries public health experts, with increasing debates on whether obesity is a chronic disease. Traditional weight loss interventions like solely relying on dietary change and exercise haven’t been impactful, with many health experts blaming fast foods and sedentary lifestyles as the root cause. Is obesity a chronic disease? Let’s explore the medical and social implications of obesity.

Understanding Obesity

Obesity is a result of many different factors, including lack of physical activity, poor dietary choices, and insufficient sleep, according to the CDC. Also, genetics can play a role, as some people have genes that increase hunger and food intake. Patients can sometimes experience obesity due to certain genetic conditions such as Prader-Willi syndrome, Bardet-Biedl syndrome, or endocrine conditions Cushing’s disease. Conditions like arthritis can lead to obesity indirectly due to reduced activity. Pharmacotherapy such as corticosteroids, many psychiatric medications, and even diabetes medications such as insulin and sulfonylureas also cause weight gain. Obesity is the biggest risk for the development of several medical conditions and complicates existing conditions in the patient. It contributes to many of the conditions treated regularly in the primary care setting including hypertension, cardiovascular disease, depression, type 2 diabetes, and obstructive sleep apnea.

What is a Chronic Disease?

A chronic disease is any condition that lasts for over three months, results in long-lasting health effects, or may not have a cure. The CDC says that six out of 10 US adults have a chronic disease, with about 40% of these patients suffering from two or more conditions. Many chronic diseases are due to physical inactivity, excessive alcohol consumption, smoking, and poor nutrition. Examples include cancer, diabetes, cerebrovascular disease, hypertension, asthma, heart disease, arthritis. Typically, chronic diseases have long latency periods and can lead to disability or functional impairment. Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the United States. They are also leading drivers of the nation’s $4.1 trillion in annual health care costs.

What Is Obesity?

Obesity is defined by the World Health Organization (WHO) as “abnormal or excessive fat accumulation that presents a risk to health.” The CDC uses body mass index (BMI), or a person's weight in kilograms divided by the square of their height in meters, to measure obesity. Individuals with a BMI of 30 or higher are considered to have obesity. While the BMI is used as an initial tool to screen for obesity, it does have limitations. The WHO recognizes these limitations, stating that BMI is only “a crude population measure of obesity.” Another definition of obesity comes from the Obesity Medicine Association (OMA) and is stated in OMA’s Obesity Algorithm® Obesity is defined by OMA as a “chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”

Is Obesity a Chronic Disease?

The prevalence of obesity has fueled public health arguments and discussions on whether it’s a chronic disease. Traditionally, society has viewed obesity as a “personal choice,” blaming patients for the weight gain due to their lifestyle and dietary choices. However, for those of us practicing obesity care on a regular basis we now understand that this is not the case. In 2013, the American Medical Association (AMA) recognized obesity as a chronic disease, helping to shape the discussions around the condition. The designation increased public awareness for obesity to help improve patient care, support research, and fight stigma. For public health experts, this was a welcomed idea, given obesity is linked to several chronic diseases, such as diabetes, heart disease, and hypertension. The World Health Organization (WHO) also recognizes obesity as a chronic disease, given that over 4 million people die yearly.

Implications of Obesity as a Chronic Disease

Access to obesity treatment has been elusive, with social media influencing patients being pushed to extreme diets and unsustainable exercise regimes to shed weight. Still, there’s hope for improved care as medical practitioners are recognizing this issue as a chronic medical condition and prescribing anti-obesity drug therapy, even though only 3% of patients used obesity medications as of 2022. Insurance coverage for obesity treatment is improving, but it’s still inconsistent, with plans not covering many anti obesity medications and surgery felt to be too extreme for many patients. Sadly, some people including health providers still view taking drugs for obesity as an “easy way out” and have even classified the medication as “vanity medication.” Interestingly, insurance plans cover obesity complications, like heart disease and diabetes, but not treatments for shedding extra weight. This is poised to change, though, as the Office of Personnel Management (OPM) met with federal employee insurance carriers and encouraged them to include anti-obesity medications in their coverage. Hopefully, this decision will give patients access to comprehensive care, as OPM offers over 200 health plans in the U.S. More importantly, it should inspire other plans, such as Medicare, to allow patients to access obesity medications.

Improving Access to Obesity Care

Obesity is a concerning issue in the US, and it’s now classified as a chronic disease. For years, society has stigmatized obesity, laying blame on patients for their increased weight. More than 40% of the US population struggle with obesity, yet access to treatment has been challenging. Given obesity increases the risk of chronic diseases including cardiovascular disease, type 2 diabetes, and hypertension, non-alcoholic fatty liver disease and certain types of cancer, public health stakeholders need to change their view on obesity. They should also push for an inclusive and comprehensive health policy to allow patients to get effective treatments. While little progress has been made as a public health issue, much can be done to improve obesity care, fight stigma and improve overall health outcomes on the individual level. Private facilities like Enara Health are taking charge to improve access to obesity care and help millions to lose pounds. Enara Health provides a sustainable virtual weight loss program that combines medications, behavioral changes through nutrition education and exercise and physical activity support. Doctors and health clinics can take advantage of such a virtual program to provide their patients with quality obesity care. Explore Enara Health to learn more about the program and how it can benefit your patients.